Basic Information
| Provider Information | |||||||||
| NPI: | 1093883241 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HERITAGE HEALTH CARE SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5640 SOUTHWYCK BLVD | ||||||||
| Address2: | STE #203 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436141569 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2312 VILLAGE PARK CT | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449061166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197479199 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | RITCH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4198672002 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | OH | Y | Agencies | Home Health |
No ID Information.